LIGHTED PATH PLLC (NPI# 1134446958) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1134446958 |
| Entity Type | Organization |
| Organization Name | LIGHTED PATH PLLC |
| Practice Address |
1124 Oak St Suite 250 Conway AR 72032-4318 |
| Mailing Address |
Po Box 224 Suite 250 Conway AR 72033-0224 |
| Practice Telephone | 8045921205 |
| Practice Fax Number | 8663888128 |
| Mailing Telephone | 8045921205 |
| Mailing Fax Number | 8663888128 |
| Enumeration Date | 2010-05-04 |
| Last Update Date | 2010-07-09 |
| Authorized Official Name | JEREMY LYNN DICICCO (PRESIDENT) |
| Authorized Official Telephone | 8045921205 |
| Authorized Official Credential | MA, LAC, CRC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 251S00000X | Community/Behavioral Health | Agencies |
| Street Address |
1124 OAK ST SUITE 250 |
| City | CONWAY |
| State | AR |
| Zip Code | 72032-4318 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942521240 | Lisa K Ray | Counselor | 1124 Oak St, Suite 205, Conway, AR 72032-4318 | 2010-06-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730789843 | Amelia S Lasater | Pharmacist | 1155 Hwy 65n, Conway, AR 72032 | 2020-10-28 |
| 1619584604 | Danyelle Durocher | Occupational Therapist | 1301 North Museum Rd, Conway, AR 72032 | 2020-09-24 |
| 1780222174 | Eric Herman Boxnick | Pharmacist | 101 West Oak Street, Conway, AR 72032 | 2019-12-16 |
| 1932746070 | Habilitation Center, LLC | Psychiatric Residential Treatment Facility | 161 Skunk Hollow Road, Conway, AR 72032 | 2019-12-09 |
| 1679051668 | Mary Elizabeth Black | Nurse Practitioner | 222 Dave Ward Drive, Conway, AR 72032 | 2018-08-01 |
| 1275035602 | Conway Dental Center Pllc | Dentist | 1600 E. Oak Street Suite B, Conway, AR 72032 | 2018-03-01 |
| 1750821625 | Luke Osborne | Physical Therapy Assistant | 1 Thomas Ln, Conway, AR 72032 | 2017-02-27 |
| 1639620099 | Sam's West, Inc. | Technician/Technologist | 1250 South Amity Rd, Conway, AR 72032 | 2016-10-20 |
| 1922559343 | Sam's West, Inc. | Durable Medical Equipment & Medical Supplies | 1250 Sourth Amity Rd, Conway, AR 72032 | 2016-10-20 |
| 1639629108 | Posture Store | Durable Medical Equipment & Medical Supplies | 3900 Dave Ward Dr., Suite 1900-130, Conway, AR 72032 | 2016-10-09 |
| Find all providers in zip 72032 | ||||
| Taxonomy Code | 251S00000X |
| Grouping | Agencies |
| Classification | Community/Behavioral Health |
| A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, mental retardation, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment. |
| Notes: Source: National Medicaid EDI HIPAA NPI Sub Work Group [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164828729 | Shoreline Behavioral Health Services | Community/Behavioral Health | 2404 Wise Road, Conway, SC 29528-0136 | 2014-11-10 |
| 1962836411 | Community Resource Solutions LLC Sc | Community/Behavioral Health | 7091 Horseshoe Cir, Conway, SC 29527-7503 | 2013-09-02 |
| 1952614653 | Potential Counseling Service | Community/Behavioral Health | 8377 Huntington Ct, Conway, SC 29527-7989 | 2010-07-22 |
| 1699909911 | Conway County Community Service Inc. | Community/Behavioral Health | 816 N Creek Dr, Conway, AR 72032-4711 | 2009-05-14 |
| 1013197540 | Dayspring Behavioral Health | Community/Behavioral Health | 1270 Bruce St, Conway, AR 72034-6511 | 2007-11-13 |
| 1548772882 | Pediatrics Plus Community Connections | Community/Behavioral Health | 2740 College Ave, Conway, AR 72034-6141 | 2017-10-26 |
| 1255782934 | New Approaches Counseling | Community/Behavioral Health | 6720 Elbow Rd, Conway, SC 29527-6471 | 2016-06-24 |
| 1730553199 | Shoreline Behavioral Health Services | Community/Behavioral Health | 2404 Wise Rd, Conway, SC 29526-5521 | 2015-11-23 |
| 1881060440 | Kairos Foundation | Community/Behavioral Health | 235 Tilk Rd, Conway, AR 72032-6648 | 2015-08-18 |
| 1346646916 | Horry County Commission | Community/Behavioral Health | 2404 Wise Rd, Conway, SC 29526-5521 | 2014-11-10 |
| Find all providers in CONWAY | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.